Regardless of any immigration guideline, all residents twenty years of age or older (with very few exceptions) must be enrolled in a public health and pension insurance plan. If you are not enrolled you face the possibility of being forced into the substandard National Health and Pension Insurance system (Kokumin Kenko Hoken & Kokumin Nenkin).

If your employer does not enroll you on the Employee Health and Pension Plan (Shakai Hoken/Shigaku Kyosai) and in the future you end up joining Kokumin Kenko Hoken (National Health Insurance) through your city office, the city government can demand two years of back payments.

The city is able to seize your assets and garnish your wages if you refuse. This is true not only for current premiums but also for the back payments mentioned above.

It is becoming more common for those who end up joining Kokumin Kenko Hoken to also start receiving bills for Kokumin Nenkin (National Pension Insurance).

If workers do not win enrollment in the Employee Health and Pension Insurance (Shakai Hoken), they must go into the National (Kokumin Kenko Hoken) system. If you manage to escape this you will also have no choice with private insurance if you: *Have a pre-existing condition.

*Have maxed out your coverage (there is often a monetary or six month cap on what treatments you will be paid for. *Also, please remember that most private health insurances do not cover children under a certain age, the elderly over a certain age, pregnancy, or dental work.